Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 416-421
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.416
Rare case of fecal impaction caused by a fecalith originating in a large colonic diverticulum: A case report
Hiroki Tanabe, Kazuyuki Tanaka, Mitsuru Goto, Tomonobu Sato, Keisuke Sato, Mikihiro Fujiya, Toshikatsu Okumura
Hiroki Tanabe, Mikihiro Fujiya, Toshikatsu Okumura, Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
Hiroki Tanabe, Kazuyuki Tanaka, Mitsuru Goto, Tomonobu Sato, Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
Keisuke Sato, Department of Pathology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
Author contributions: Tanabe H wrote the manuscript; Tanaka K collected the data and figures; Goto M and Sato T performed the endoscopic examination; Sato K performed a histological examination; Fujiya M and Okumura T revised the manuscript and reviewed the report; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare no competing interests in association with the present study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hiroki Tanabe, MD, PhD, Doctor, Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Hokkaido, Japan.
Received: August 6, 2020
Peer-review started: August 6, 2020
First decision: November 8, 2020
Revised: November 18, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 16, 2021

Fecal impaction is defined as a large mass of compacted feces in the colon and has the potential to induce a serious medical condition in elderly individuals. Fecal impaction is generally preventable, and early recognition of the typical radiological findings is important for making an early diagnosis. The factors that lead to fecal impaction are usually similar to those causing constipation. Few cases with fecal impaction associated with a diverticulum have been reported.


We present the case of a 62-year-old woman who suffered from abdominal pain and vomiting, had a medical history of repeated acute abdomen and was diagnosed with fecal impaction in the descending colon based on X-ray and computed tomography (CT) imaging. After examination by gastrografin-enhanced colonography following colonoscopy and CT colonography, the fecalith was suspected to have been produced at the site of a large diverticulum in the transverse colon. The fecalith was surgically resected, and a histological diagnosis of pseudodiverticulum was made. There was no recurrence during 33 mo of follow-up.


This case highlights the importance of accurate identification and treatment of a fecal impaction. This case indicated that the endoscopic evacuation and subsequent colonography were effective for identifying a diverticulum that might have caused fecal impaction. A fecal impaction was associated with the diverticulum. Consequently, the planned diverticulectomy was performed. Appropriate emergency medical treatment and maintenance treatments should be selected in such cases to prevent recurrence.

Keywords: Colonic ileus, Constipation, Acute abdomen, Computed tomograp-hy colonography, Case report, Colonoscopy

Core Tip: A 62-year-old woman presented to the emergency department with abdominal pain and vomiting. She had several medical histories of treatment for ileus over the past four years, but no specific findings were detected by colonoscopy. Fecal impaction was observed by computed tomography (CT), and the fecalith was broken and removed by colonoscopy. CT colonography verified the presence of a colonic diverticulum, which was suspected to have been responsible for the fecalith. After the surgery on the diverticulum, the patient became free from any further episodes of abdominal pain. A fecalith can be caused by a giant diverticulum that is not evident on colonoscopy.